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Chronic Pancreatitis
Siva P. Raman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Progressive, irreversible inflammatory damage to pancreas resulting in parenchymal fibrosis, morphologic changes, and loss of endocrine/exocrine function

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Nuclear Medicine Findings

                  • Radiographic Findings

                    • Ultrasonographic Findings

                      • Angiographic Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Kamat R et al: Imaging in chronic pancreatitis: state of the art review. Indian J Radiol Imaging. 29(2):201-10, 2019
                                              2. Singh VK et al: Diagnosis and management of chronic pancreatitis: a review. JAMA. 322(24):2422-34, 2019
                                              3. Tirkes T et al: Reporting standards for chronic pancreatitis by using CT, MRI, and MR cholangiopancreatography: the consortium for the study of chronic pancreatitis, diabetes, and pancreatic cancer. Radiology. 290(1):207-15, 2019
                                              4. Wolske KM et al: Chronic pancreatitis or pancreatic tumor? A problem-solving approach. Radiographics. 39(7):1965-82, 2019
                                              5. Parekh D et al: Surgical management of chronic pancreatitis. Indian J Surg. 77(5):453-69, 2015
                                              6. Gupte AR et al: Chronic pancreatitis. Curr Opin Gastroenterol. 30(5):500-5, 2014
                                              7. Manikkavasakar S et al: Magnetic resonance imaging of pancreatitis: an update. World J Gastroenterol. 20(40):14760-77, 2014
                                              8. O'Neill E et al: MR imaging of the pancreas. Radiol Clin North Am. 52(4):757-77, 2014
                                              9. Raman SP et al: Endoscopic ultrasound and pancreatic applications: what the radiologist needs to know. Abdom Imaging. 38(6):1360-72, 2013
                                              10. Tirkes T et al: Secretin-enhanced MR cholangiopancreatography: spectrum of findings. Radiographics. 33(7):1889-906, 2013
                                              11. Arikawa S et al: Assessment of chronic pancreatitis: use of whole pancreas perfusion with 256-slice computed tomography. Pancreas. 41(4):535-40, 2012
                                              12. Zamboni GA et al: Dynamic MDCT of the pancreas: is time-density curve morphology useful for the differential diagnosis of solid lesions? A preliminary report. Eur J Radiol. 81(3):e381-5, 2012
                                              13. Lu N et al: 64-slice CT perfusion imaging of pancreatic adenocarcinoma and mass-forming chronic pancreatitis. Acad Radiol. 18(1):81-8, 2011
                                              14. Andersson R et al: Pathogenesis of chronic pancreatitis: a comprehensive update and a look into the future. Scand J Gastroenterol. 44(6):661-3, 2009
                                              15. Aoun E et al: Pathways to injury in chronic pancreatitis: decoding the role of the high-risk SPINK1 N34S haplotype using meta-analysis. PLoS ONE. 3(4):e2003, 2008
                                              16. Aoun E et al: Rapid evolution from the first episode of acute pancreatitis to chronic pancreatitis in human subjects. JOP. 8(5):573-8, 2007
                                              17. Fink EN et al: Genetic counseling for nonsyndromic pancreatitis. Gastroenterol Clin North Am. 36(2):325-33, ix, 2007
                                              18. Tamura R et al: Chronic pancreatitis: MRCP versus ERCP for quantitative caliber measurement and qualitative evaluation. Radiology. 238(3):920-8, 2006
                                              19. Park MS et al: Differentiation of extrahepatic bile duct cholangiocarcinoma from benign stricture: findings at MRCP versus ERCP. Radiology. 233(1):234-40, 2004
                                              20. Manfredi R et al: Idiopathic chronic pancreatitis in children: MR cholangiopancreatography after secretin administration. Radiology. 224(3):675-82, 2002
                                              21. Matos C et al: MR imaging of the pancreas: a pictorial tour. Radiographics. 22(1):e2, 2002
                                              22. Remer EM et al: Imaging of chronic pancreatitis. Radiol Clin North Am. 40(6):1229-42, v, 2002
                                              23. Varghese JC et al: Value of MR pancreatography in the evaluation of patients with chronic pancreatitis. Clin Radiol. 57(5):393-401, 2002
                                              24. Ichikawa T et al: Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas. Radiology. 221(1):107-16, 2001
                                              25. Kim T et al: Pancreatic mass due to chronic pancreatitis: correlation of CT and MR imaging features with pathologic findings. AJR Am J Roentgenol. 177(2):367-71, 2001
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Definitions

                                                        • Progressive, irreversible inflammatory damage to pancreas resulting in parenchymal fibrosis, morphologic changes, and loss of endocrine/exocrine function

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Nuclear Medicine Findings

                                                              • Radiographic Findings

                                                                • Ultrasonographic Findings

                                                                  • Angiographic Findings

                                                                    • Imaging Recommendations

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Kamat R et al: Imaging in chronic pancreatitis: state of the art review. Indian J Radiol Imaging. 29(2):201-10, 2019
                                                                                          2. Singh VK et al: Diagnosis and management of chronic pancreatitis: a review. JAMA. 322(24):2422-34, 2019
                                                                                          3. Tirkes T et al: Reporting standards for chronic pancreatitis by using CT, MRI, and MR cholangiopancreatography: the consortium for the study of chronic pancreatitis, diabetes, and pancreatic cancer. Radiology. 290(1):207-15, 2019
                                                                                          4. Wolske KM et al: Chronic pancreatitis or pancreatic tumor? A problem-solving approach. Radiographics. 39(7):1965-82, 2019
                                                                                          5. Parekh D et al: Surgical management of chronic pancreatitis. Indian J Surg. 77(5):453-69, 2015
                                                                                          6. Gupte AR et al: Chronic pancreatitis. Curr Opin Gastroenterol. 30(5):500-5, 2014
                                                                                          7. Manikkavasakar S et al: Magnetic resonance imaging of pancreatitis: an update. World J Gastroenterol. 20(40):14760-77, 2014
                                                                                          8. O'Neill E et al: MR imaging of the pancreas. Radiol Clin North Am. 52(4):757-77, 2014
                                                                                          9. Raman SP et al: Endoscopic ultrasound and pancreatic applications: what the radiologist needs to know. Abdom Imaging. 38(6):1360-72, 2013
                                                                                          10. Tirkes T et al: Secretin-enhanced MR cholangiopancreatography: spectrum of findings. Radiographics. 33(7):1889-906, 2013
                                                                                          11. Arikawa S et al: Assessment of chronic pancreatitis: use of whole pancreas perfusion with 256-slice computed tomography. Pancreas. 41(4):535-40, 2012
                                                                                          12. Zamboni GA et al: Dynamic MDCT of the pancreas: is time-density curve morphology useful for the differential diagnosis of solid lesions? A preliminary report. Eur J Radiol. 81(3):e381-5, 2012
                                                                                          13. Lu N et al: 64-slice CT perfusion imaging of pancreatic adenocarcinoma and mass-forming chronic pancreatitis. Acad Radiol. 18(1):81-8, 2011
                                                                                          14. Andersson R et al: Pathogenesis of chronic pancreatitis: a comprehensive update and a look into the future. Scand J Gastroenterol. 44(6):661-3, 2009
                                                                                          15. Aoun E et al: Pathways to injury in chronic pancreatitis: decoding the role of the high-risk SPINK1 N34S haplotype using meta-analysis. PLoS ONE. 3(4):e2003, 2008
                                                                                          16. Aoun E et al: Rapid evolution from the first episode of acute pancreatitis to chronic pancreatitis in human subjects. JOP. 8(5):573-8, 2007
                                                                                          17. Fink EN et al: Genetic counseling for nonsyndromic pancreatitis. Gastroenterol Clin North Am. 36(2):325-33, ix, 2007
                                                                                          18. Tamura R et al: Chronic pancreatitis: MRCP versus ERCP for quantitative caliber measurement and qualitative evaluation. Radiology. 238(3):920-8, 2006
                                                                                          19. Park MS et al: Differentiation of extrahepatic bile duct cholangiocarcinoma from benign stricture: findings at MRCP versus ERCP. Radiology. 233(1):234-40, 2004
                                                                                          20. Manfredi R et al: Idiopathic chronic pancreatitis in children: MR cholangiopancreatography after secretin administration. Radiology. 224(3):675-82, 2002
                                                                                          21. Matos C et al: MR imaging of the pancreas: a pictorial tour. Radiographics. 22(1):e2, 2002
                                                                                          22. Remer EM et al: Imaging of chronic pancreatitis. Radiol Clin North Am. 40(6):1229-42, v, 2002
                                                                                          23. Varghese JC et al: Value of MR pancreatography in the evaluation of patients with chronic pancreatitis. Clin Radiol. 57(5):393-401, 2002
                                                                                          24. Ichikawa T et al: Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas. Radiology. 221(1):107-16, 2001
                                                                                          25. Kim T et al: Pancreatic mass due to chronic pancreatitis: correlation of CT and MR imaging features with pathologic findings. AJR Am J Roentgenol. 177(2):367-71, 2001